Value of Thrombus CT Characteristics in Patients with Acute Ischemic Stroke

Borst, Jordi; Berkhemer, Olvert A.; Santos, Emilie M. M.; Yoo, Albert J.; Blanken, Mark D. den; Roos, Yvo B.W.E.M.; VanBavel, Ed; Zwam, Wim H van; Oostenbrugge, Robert J. van; Lingsma, Hester F.; Lugt, Aad van der; Dippel, Diederik W.J.; Marquering, Henk A.; Majoie, Charles B. L. M.

doi:10.3174/ajnr.a5331

Cited by 36 publications

(28 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For endovascular recanalization therapy, most studies examining the association between perviousness and thrombectomy outcomes have concluded that patients with pervious clots are more likely to be successfully recanalized and will have better outcomes. However this notion has been refuted in at least one subsequent study 6 20 21. By correlating the TAI with clot composition, our study offers a histologic explanation for the association between clot perviousness on imaging and favorable outcomes.…”

Section: Discussionmentioning

confidence: 76%

Clot permeability and histopathology: is a clot’s perviousness on CT imaging correlated with its histologic composition?

Benson

Fitzgerald

Kadirvel

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundClot perviousness in large vessel occlusion has been shown to be associated with improved recanalization outcomes with mechanical thrombectomy and intravenous thrombolysis.ObjectiveTo evaluate the association between clot perviousness based on thrombus attenuation increase (TAI) on CT, and histologic composition of clots in acute ischemic stroke (AIS).MethodsA retrospective review was completed of patients with AIS secondary to large vessel occlusion, non-contrast CT (NCCT) and CT angiography (CTA) images, and histologic analysis of the retrieved clot. TAI was measured by subtracting clot attenuation on NCCT from the attenuation on CTA. Up to 3 regions of interest (ROIs) were evaluated on each clot; the average attenuation was used for analysis if multiple ROIs were assessed. Pervious clots were defined as TAI ≥10 Hounsfield units (HUs); impervious clots had TAI <10 HU. Histopathologic analyses of clots were assessed for relative compositions of red blood cells (RBCs), white blood cells (WBCs), fibrin, and platelets/other.Results57 patients were included. Pervious clots were more likely to be RBC rich (p=0.04); impervious clots were more likely to be fibrin and WBC rich (p=0.01 for both). Pervious clots also had greater RBC density than impervious clots (49.8% and 33.0%, respectively; p=0.006); fibrin density of pervious clots was lower than that of impervious clots (17.8% and 23.2%, respectively; p=0.02).ConclusionClot perviousness, assessed on NCCT and CTA imaging, is associated with higher RBC density and lower fibrin density, offering a possible explanation for the higher rates of successful thrombectomy and favorable clinical outcome seen in such patients.

show abstract

Section: Discussionmentioning

confidence: 76%

Clot permeability and histopathology: is a clot’s perviousness on CT imaging correlated with its histologic composition?

Benson

Fitzgerald

Kadirvel

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…Previous studies did not find a relationship between clot size, volume or density, and the efficacy of endovascular treatment. 24 Similarly, these parameters were not associated with rapid recanalization in our study or in a previous trial predicting a response to recombinant tPA (tissue-type plasminogen activator) therapy 17 and thus were not selected in our final models. However, due to the automatic calculation of numerous RF, we were able to identify several other imaging biomarkers of the clot associated with a good response to endovascular treatment.…”

Section: Discussionmentioning

confidence: 86%

Clot-Based Radiomics Predict a Mechanical Thrombectomy Strategy for Successful Recanalization in Acute Ischemic Stroke

Hofmeister

Bernava

Rosi

et al. 2020

Stroke

View full text Add to dashboard Cite

Background and Purpose: Mechanical thrombectomy (MTB) is a reference treatment for acute ischemic stroke, with several endovascular strategies currently available. However, no quantitative methods are available for the selection of the best endovascular strategy or to predict the difficulty of clot removal. We aimed to investigate the predictive value of an endovascular strategy based on radiomic features extracted from the clot on preinterventional, noncontrast computed tomography to identify patients with first-attempt recanalization with thromboaspiration and to predict the overall number of passages needed with an MTB device for successful recanalization. Methods: We performed a study including 2 cohorts of patients admitted to our hospital: a retrospective training cohort (n=109) and a prospective validation cohort (n=47). Thrombi were segmented on noncontrast computed tomography, followed by the automatic computation of 1485 thrombus-related radiomic features. After selection of the relevant features, 2 machine learning models were developed on the training cohort to predict (1) first-attempt recanalization with thromboaspiration and (2) the overall number of passages with MTB devices for successful recanalization. The performance of the models was evaluated on the prospective validation cohort. Results: A small subset of radiomic features (n=9) was predictive of first-attempt recanalization with thromboaspiration (receiver operating characteristic curve–area under the curve, 0.88). The same subset also predicted the overall number of passages required for successful recanalization (explained variance, 0.70; mean squared error, 0.76; Pearson correlation coefficient, 0.73; P <0.05). Conclusions: Clot-based radiomics have the ability to predict an MTB strategy for successful recanalization in acute ischemic stroke, thus allowing a potentially better selection of the MTB strategy, as well as patients who are most likely to benefit from the intervention.

show abstract

“…30 Second, the higher incidence of distal occlusions is also associated with smaller ischemic core and better functional outcome. 31,32 Because of our definitions, the thrombus growth group did not include ICA occlusions on CTA, whereas almost one quarter of patients on the stable group had such ICA occlusions. This may explain why there was also a trend towards better functional outcome on patients with thrombus growth and why this association was lost when only M1 initial target occlusion was included on both groups.…”

Section: Discussionmentioning

confidence: 99%

Thrombus Migration Paradox in Patients With Acute Ischemic Stroke

Alves

Treurniet

Jansen

et al. 2019

Stroke

View full text Add to dashboard Cite

Background and Purpose— The location of the thrombus as observed on first digital subtraction angiography during endovascular treatment may differ from the initial observation on initial noninvasive imaging. We studied the incidence of thrombus dynamics, its impact on patient outcomes, and its association with intravenous thrombolytics. Methods— We included patients from the MR CLEAN registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) with an initial target occlusion on computed tomography angiography located in the intracranial internal carotid artery, M1, or M2. The conventional angiography target occlusion was defined during endovascular treatment. Thrombus dynamics were classified as growth, stability, migration, and resolution. The primary outcome was functional outcome at 90 days (modified Rankin Scale). The secondary outcomes were successful and complete reperfusion (extended treatment in cerebral infarction scores of 2b-3 and 3, respectively). Results— The analysis included 1349 patients. Thrombus migration occurred in 302 (22%) patients, thrombus growth in 87 (6%), and thrombus resolution in 39 (3%). Intravenous treatment with alteplase was associated with more thrombus migration (adjusted odds ratio, 2.01; CI, 1.29–3.11) and thrombus resolution (adjusted odds ratio, 1.85; CI, 1.22–2.80). Thrombus migration was associated with a lower chance of complete reperfusion (adjusted odds ratio, 0.57; CI, 0.42–0.78) and successful reperfusion (adjusted odds ratio, 0.74; CI, 0.55–0.99). In the subgroup of patients with M1 initial target occlusion, thrombus migration was associated with better functional outcome (adjusted common odds ratio, 1.49; CI, 1.02–2.17), and there was a trend towards better functional outcome in patients with thrombus resolution (adjusted common odds ratio, 2.23; CI, 0.93–5.37). Conclusions— In patients with acute ischemic stroke, thrombus location regularly changes between computed tomography angiography and digital subtraction angiography. Administration of intravenous alteplase increases the chance of thrombus migration and resolution. Thrombus migration is associated with better functional outcome but reduces the rate of complete reperfusion.

show abstract

Value of Thrombus CT Characteristics in Patients with Acute Ischemic Stroke

Cited by 36 publications

References 29 publications

Clot permeability and histopathology: is a clot’s perviousness on CT imaging correlated with its histologic composition?

Clot permeability and histopathology: is a clot’s perviousness on CT imaging correlated with its histologic composition?

Clot-Based Radiomics Predict a Mechanical Thrombectomy Strategy for Successful Recanalization in Acute Ischemic Stroke

Thrombus Migration Paradox in Patients With Acute Ischemic Stroke

Contact Info

Product

Resources

About